Tag Archives: There are 72 Hours in a Day

Straight No Chaser: Identifying Risks of Domestic Violence

October 4, 2017Endocrine/Metabolic, Mental Health, Surgical Care, Trauma844-SMA-TALK, Behind the Curtain, domestic violence, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Today we point to knowledge as the key to preventing potential life-threatening episodes in the household. This is the second in a three-part series on domestic violence. The previous post focused on the scope of domestic violence. The next post will focus on actions to take if you find yourself in a relationship in which domestic violence occurs.
Certain environments or conditions may increase your risk of becoming a victim of domestic violence. Here are certain considerations that suggest you may be at risk:

Drugs and alcohol can exacerbate an already volatile situation.
Be aware that pregnancy is a particularly sensitive time emotionally, during which abuse may start or increase.
Women with fewer resources or greater perceived vulnerability—girls and those experiencing physical or psychiatric disabilities or living below the poverty line—are at even greater risk for domestic violence and lifetime abuse.

Children are also affected by domestic violence, even if they do not witness it directly. To protect them and yourself, evaluate your mate or others in a position to exert control over you. Abusers are masterful at isolating, manipulating, intimidating and controlling those they abuse. Abusers don’t always attack with a frontal assault. Abuse may begin slowly and progress. You may accommodate certain demands in an effort to “keep the peace” in your relationship and then find yourself beyond an easy retreat from a once generous and loving person who is now intimidating and threatening.
The insidious nature of abuse must be reemphasized. What may seem, at first, to be an isolated incident complicated by theoretically understandable factors may grow into a way of life with seemingly small events triggering abuse. Your abuser may change from an individual showing regret and remorse to someone who seems repulsed by your existence, blaming your every action (or inaction or anticipated action) for the abuse that follows.
The following conditions and circumstances have been associated with propensities for abuse. Don’t consider these as absolute predictors as much as risk factors about which you should be aware.

Whirlwind romance
Abnormal desire to be with you all the time
Tracking what you’re doing and who you’re with
Jealousy at any perceived attention to or from others
Attempting to isolate you in the guise of loving behavior, including going to lengths to convince you that your friends and family don’t adequately care for you (e.g., “You don’t need to work or go to school” or “We only need each other”)
Hypersensitivity to perceived slights
Quick to blame you or others for the abuse
Pressuring you into doing things you aren’t comfortable with (e.g., “If you really love me, you’ll do this for me”)

Are you at risk? Ask yourself these questions.

Are you ever afraid of your partner?
Has your partner ever hurt or threatened to hurt you physically or someone you care about?
Does your partner ever force you to engage in sexual activities that make you uncomfortable?
Do you constantly worry about your partner’s moods and change your behavior to deal with them?
Does your partner try to control where you go, what you do and who you see?
Does your partner constantly accuse you of having affairs?
Have you stopped seeing family or friends to avoid your partner’s jealousy or anger?
Does your partner control your finances?
Does he/she threaten to kill him/herself if you leave?
Does your partner claim his/her temper is out of control due to alcohol, drugs or because he/she had an abusive childhood?

If you answer yes to some or all of these questions, you could be at risk for or already suffering abuse.
In the next Straight, No Chaser, we’ll discuss actions you can take to protect yourself and remove yourself from an abusive environment.
It’s personal. We understand and we can help. Please … contact us if you’re in need of support. Our expert crisis counselors are here for you, 24/7. 1-844-SMA-TALK or www.SterlingMedicalAdvice.com. You don’t have to “endure with dignity.”
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Focus on Domestic Violence

October 3, 2017Trauma844-SMA-TALK, Behind the Curtain, domestic violence, national domestic violence hotline, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

October is Domestic Violence Awareness Month, although it doesn’t take a break during other months. Are you concerned about domestic violence? You are not alone. Domestic violence occurs in every culture and society. It occurs in all age groups and in men and women. It occurs in all races, income levels and religions. It occurs in heterosexual and homosexual relationships. It is estimated that one in four women and one in nine men will be victims of domestic violence at some point in their lives. That’s right. Many (if not most) emergency rooms now screen every single woman for domestic violence. You need to know the signs of danger and what you can do to get help.
This is the first in a three-part series on domestic violence. This post will focus on the scope of domestic violence. The next post will focus on identifying risk factors. The third post will focus on actions to take if you find yourself in a relationship in which domestic violence occurs.
Domestic violence is the abuse that one person with control in a household inflicts on another. Perpetrators can include parents or other caregivers, siblings, spouses or intimate partners. Domestic violence reveals itself in several forms, including sexual (e.g., rape), physical (e.g., biting, hitting, kicking) and mental abuse (e.g., constant criticisms or threats, limiting ability to lead otherwise normal lives). These forms tend to center around abnormal control of an aspect of another’s life. The level of mental control is such that victims of domestic violence often internalize the activity as normal, assign fault to themselves and/or accept responsibility for the abuse.

Domestic violence is a crime in all 50 states of the U.S.

It is a crime.

Victims do not cause abuse and are not responsible for it.

Domestic violence has consistent adverse effects on mental health.

Children suffering from domestic violence often display developmental delays, aggressive behavior, difficulty performing in school and low self-esteem. They are at greater risk for being diagnosed with a psychiatric disorder.
Domestic violence increases the diagnoses of anxiety disorder, depression, panic attacks and post-traumatic stress disorder. It is associated with an increase in substance abuse.
Domestic violence increases the incidence of psychotic episodes, suicide attempts and homelessness. It’s presence slows recovery from those suffering from other mental illness.
Domestic violence increases the risk of retaliatory violence against the perpetrators.

Please … contact us if you’re in need of support. Our expert crisis counselors are here for you, 24/7. 1-844-SMA-TALK or www.SterlingMedicalAdvice.com. You don’t have to “endure with dignity.”
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Keys to Mental (Un)Health and (Un)Happiness

October 2, 2017General Health and Wellness, Mental Health, Ophthalmology/Eyes844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Straight, No Chaser is mindful that there are multitudes of us excessively happy and unhappy. Everyone has thoughts about the keys to happiness, but we can objectify the conversation and identify what’s most likely to make you unhappy and lead to depression. You may find this hard to believe, but outside of medical causes of psychiatric illness and factors outside of your control, there are actually three choices we make that most commonly adversely impact your happiness and good mental health. Take it for what you will, but the data is what it is. Stay away from these circumstances, and you’re less likely to be unhappy. Sometimes it’s about addition by subtraction.

Health Problems: People who are sick or have significant illness in their families generally aren’t happy. Although this may seem obvious and perhaps unfair, given that some illnesses and conditions are inherited or occur haphazardly, be mindful of the things you can control. Of course, this gets to the negative effects of obesity and smoking. More so than any other health-related activities/conditions, these will eventually lead to deteriorating health and subsequent unhappiness.

Job Problems: You don’t have enough to do with your time? Yep, an idle mind is the Devil’s workshop, as the saying goes. It should be pointed out that neither too much work nor the wrong type of work (i.e., low job satisfaction) seems to promote happiness. On average, people change careers seven times during their lifetimes. It’s often due to a search for happiness and actually is a good thing to do to avoid being stuck in a bad situation. Follow the job you love, and you’re more likely to be both happy and successful.

Relationship Problems: You make bad relationship choices? Well there’s one specific choice that is shown to be most likely to reduce your happiness—choosing a neurotic partner. What’s neurotic? For one particularly disruptive example, think about the so-called Drama Queen/King. A neurotic partner responds emotionally to events that wouldn’t affect most people, and their reactions tend to be more intense than normal. They’re more likely to interpret minor frustrations as hopelessly difficult. Their negative emotional reactions persist for unusually long periods of time. In short, if you want to be really unhappy, become attached to such a person. They will negatively affect your world, keeping you embroiled in drama and unhappiness, no matter how good the financial, physical, or other parts of your relationship.

Now your results may vary but probably won’t. I’m not make judgements, just sharing the data. Life choices have consequences. Choose wisely!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Tips to Avoid Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected

October 1, 2017Pediatrics/Kids Health, Surgical Care, Health Prevention844-SMA-TALK, Behind the Curtain, SIDS, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, sudden infant death syndrome, sudden unexpected infant deaths, SUID, There are 72 Hours in a DayJeffrey Sterling, MD

Whether you’re expecting, a parent or even a grandparent, most have heard of SIDS (Sudden Infant Death Syndrome). What you’re really concerned about is Sudden Unexpected Infant Deaths (SUID); SIDS is the leading cause of this category. SUID is defined as sudden and unexpected deaths in infants less than 1 year of age whose causes are not immediately apparent. This represents approximately 4,000 infant deaths per year in the U.S. The three most frequently reported causes of SUID are SIDS, cause unknown, and accidental suffocation and strangulation in bed. Approximately half of SUID cases are due to SIDS. This Straight, No Chaser post provides tips for you modified from recommendations by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP); these tips are meant to help you reduce the risk of SIDS and SUID in your home.Consider these tips applicable for the first year:

Place your baby to sleep on his back for every sleep and nap.
Place your baby to sleep on a firm sleep surface. Never put your baby to sleep on a chair, sofa, waterbed, cushion, or sheepskin.
If your baby falls asleep in a car safety seat, stroller, swing, infant carrier, or infant sling he should be moved to a firm sleep surface as soon as possible.

Do not use a crib that is broken or missing parts, or has drop-side rails.
Cover you baby’s mattress with a fitted sheet. Do not put blankets or pillows between the mattress and the fitted sheet.
Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the crib. Pillows, quilts, comforters, sheepskins, bumper pads, and stuffed toys can cause your baby to suffocate.

Place your baby to sleep in the same room where you sleep but not the same bed. Keep the crib or bassinet within an arm’s reach of your bed. You can easily watch or breastfeed your baby by having your baby nearby. Babies who sleep in the same bed as their parents are at risk of SIDS, suffocation, or strangulation. Parents can roll onto babies during sleep or babies can get tangled in the sheets or blankets.

Breastfeed as much and for as long as you can. Studies show that breastfeeding your baby can help reduce the risk of SIDS.
Schedule and go to all well-child visits. Your baby will receive important immunizations. Recent evidence suggests that immunizations may have a protective effect against SIDS.
Keep your baby away from smokers and places where people smoke. Keep your car and home smoke-free. Don’t smoke inside your home or car and don’t smoke anywhere near your baby, even if you are outside.

Do not let your baby get too hot. Keep the room where your baby sleeps at a comfortable temperature. In general, dress your baby in no more than one extra layer than you would wear. Your baby may be too hot if she is sweating or if her chest feels hot.
Offer a pacifier at nap time and bedtime. This helps to reduce the risk of SIDS. If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes 3 to 4 weeks.

Do not use home cardiorespiratory monitors to help reduce the risk of SIDS. Home cardiorespiratory monitors can be helpful for babies with breathing or heart problems but they have not been found to reduce the risk of SIDS.
Do not use products that claim to reduce the risk of SIDS. Products such as wedges, positioners, special mattresses, and specialized sleep surfaces have not been shown to reduce the risk of SIDS. In addition, some infants have suffocated while using these products.

Give your baby plenty of “tummy time” when she is awake and you are present. This will help strengthen neck muscles and avoid flat spots on the head. Always stay with your baby during tummy time and make sure she is awake.

If you’re an expectant mom, go to all prenatal doctor visits. Do not smoke, drink alcohol, or use drugs while pregnant and after birth.

Keep these tips handy. We certainly don’t want your sudden bundle of joy to become a victim of Sudden Infant Death Syndrome.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Traumatic Brain Injuries (Concussion), Part II

September 30, 2017Neurology, Trauma844-SMA-TALK, Behind the Curtain, CDC, Centers for Disease Control and Prevention, Concussion, Post-concussion syndrome, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, Traumatic brain injuryJeffrey Sterling, MD

Your son is a star in Friday Night Lights (actually football, not the TV show) and has been concussed. Amazingly, the most common question I get asked is not “Will he be ok?”, but “When will he be able to get back on the field?” My answer, coming out the ER, is never going to be less than two weeks, and I won’t be the one who provides medical clearance. It’ll either be your family doctor or preferably, a neurologist. Don’t just take my word for it. Consider the following Quick Tips from the Center for Disease Control and Preventions.
CDC’s Discharge Instructions

You may experience a range of symptoms over the next few days, such as difficulty concentrating, dizziness or trouble falling asleep. These symptoms can be part of the normal healing process, and most go away over time without any treatment.
Return immediately to the ED if you have worsening or severe headache, lose consciousness, increased vomiting, increasing confusion, seizures, numbness or any symptom that concerns you, your family, or friends.
Tell a family member or friend about your head injury and ask them to help monitor you for more serious symptoms. Get plenty of rest and sleep, and return gradually and slowly to your usually routines. Don’t drink alcohol. Avoid activities that are physically demanding or require a lot of concentration.
If you don’t feel better after a week, see a doctor who has experience treating brain injuries.
Don’t return to sports before talking to your doctor. A repeat blow to your head-before your brain has time to heal-can be very dangerous and may slow recovery or increase the chance for long-term problems.

Finally, there are two particularly impactful consequences about which you should be aware.

The ‘second impact syndrome’ is irreversible brain injury triggered by a fairly routine second head impact after a prior concussion. You must take the time off needed for the brain to heal. I care more about your child’s mental future than the upcoming playoff game.
The ‘post-concussive syndrome’ represents long-term neurologic and psychologic consequences of the head injury. It includes such symptoms as inability to sleep, irritability, inability to concentrate, headache, dizziness and anxiety.

There are no definitive treatments for concussions other than prevention of an additional injury, and that fact should be chilling to you. Be mindful of the risks involved in choosing to engage in activities putting the brain at risk.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Traumatic Brain Injuries (Concussions), Part I

September 29, 2017Neurology, Trauma844-SMA-TALK, Behind the Curtain, Concussions, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, Traumatic brain injuryJeffrey Sterling, MD

It’s probably not a coincidence that National Traumatic Brain Injury Awareness Month occurs at the same time as the onset of the NFL season in the U.S. However, it’s also important to appreciate that traumatic brain injuries (TBIs) don’t only occur in the setting of professional sports. Regarding sports, the really interesting thing about concussions these days is many individuals seem to have convinced themselves that the risk of a concussion or even continuing in football, wrestling, boxing, or MMA type activities after having had concussions won’t deter them from pursuing the glory, fame, and fortune to be obtained in putting themselves at risk. That’s a fascinating but very flawed concept, as evidenced by the increasing suicide rate among concussed former athletes.

A traumatic brain injury (TBI) is caused by a blunt or penetrating head blow that disrupts some aspect of normal brain function. TBIs may produce changes, ranging from brief alterations in mental status or consciousness to an extended period of unconsciousness or amnesia. (It’s important to note that not all blows to the head result in a TBI.) For the purposes of this discussion, the majority of TBIs that occur each year are concussions. In terms of societal impact, TBIs contribute to a remarkable number of deaths and permanent disability. Every year, at least 1.7 million TBIs occur in the US.

Healthcare professionals may describe a concussion as a “mild” brain injury because concussions are usually not life threatening. Even so, their effects can be serious. Concussive symptoms usually fall in one of four categories:

Thinking/remembering
Physical
Emotional/mood
Sleep

Red Flags
Here’s what you need to know today. Get to the ER right away if you have any of the following danger signs after any type of head injury, no matter how minor it may seem:

Any difficulty waking
Any loss of consciousness, confusion, or significant agitation
One pupil (the black part in the middle of the eye) larger than the other
Loss of ability to identify people, places, the date, or self
Loss of motion or sensation, weakness, numbness or loss of coordination
Persistent, worsening headache
Repeated vomiting
Slurred speech or difficulty with expression
Seizures
Kids will not stop crying and cannot be consoled
Kids will not nurse or eat

We’ll continue the conversation about concussions in the next Straight, No Chaser.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: MRSA, the Big, Bad Staph Infection

September 28, 2017Infectious Disease, Skin/Dermatology844-SMA-TALK, Antibiotic resistance, Behind the Curtain, Infection, Methicillin-resistant Staphylococcus aureus, MRSA, Spider bite, Staphylococcus, Staphylococcus aureus, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

One of the things that’s changed a lot from when I first started practicing medicine is people show up every day to the emergency room for mosquito and spider bites. The local news has done a number on you, as now everyone is afraid of MRSA.
Methicillin-resistant Staph Aureus (MRSA) is a bacterial infection that’s resistant to the penicillin family of drugs that we used for decades to treat many infections. Staph Aureus itself is a bacteria akin to flipping a light switch. Normally, it resides within us (approximately 30% of us have it in our nostrils but only 2% of us carry the MRSA variety), not causing any problems, but it is also the source of many dangerous and life-threatening illnesses if it enters your bloodstream.
Over the last 50 years of treating Staph infections, resistance to many different antibiotics has occurred, meaning that when a serious infection occurs, it’s potentially very harmful. The emphasis there should be on potentially. Most MRSA infections are community-acquired skin infections that resemble a spider or other insect bite but are still mild and are treatable with different antibiotics than historically used. Regular Staph and MRSA infections are even more likely to occur in those institutionalized (i.e. in hospitals, nursing homes, etc.) and have tubes and wounds. Consider and discuss the risk with your physician when you see someone on a breathing device, a urinary catheter, needing gauze for surgical wounds or on feeding tubes. Amazingly, MRSA causes approximately 60% of hospital-acquired Staph infections now.
My primary goal today is to inform you of what you need to know to prevent obtaining these infections and when to be especially diligent in seeking treatment. It’s really a simple task of maintaining hygiene. Just prevent that ‘light-switch’ from flipping to the on position and most times you’ll be ok.
1. Staph is everywhere. You can best protect yourself by simply practicing good hygiene. Wash your hands early and often.
2. MRSA is spread by contact. Don’t be so quick to feel and squeeze on someone’s (or your own) boil. Wash your hands before and after such contact. Don’t share towels or razors.
3. Keep any cuts, scratches, nicks or scrapes covered until healed.
If you do see or develop signs of a skin infection (redness, warmth, tenderness, pain and possibly discharge from the wound site), it’s worth contacting your physician to see if s/he’d like to start antibiotics or drain a possible abscess.
So… don’t be afraid, be smart. Prevention is key.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Abscesses (Boils)

September 27, 2017Infectious Disease, Skin/Dermatology844-SMA-TALK, Abscess, Cellulitis, Folliculitis, Incision and drainage, Methicillin-resistant Staphylococcus aureus, Staph, Staphylococcus aureus, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, streptococcus, There are 72 Hours in a DayJeffrey Sterling, MD

Whether you call them boils, pus pockets or abscesses, they hurt. Abscesses are infections that localize and collect pus beneath the skin. Although previous Straight, No Chaser posts have addressed MRSA, this one will highlight your frequently asked questions about abscesses.

Why do I get an abscess?
Something causes an injury or sufficient irritation to your skin to allow bacteria to enter, and/or your lowered immunity can’t adequately fight back. Examples of circumstances causing skin infections that can develop into abscesses include ingrown hairs (folliculitis), insect bites and IV drug use. You are at increased risk for developing an abscess if you have diabetes, are obese, use IV drugs, have a weakened immune system or have an untreated skin infection (cellulitis).

What causes abscesses?
Bacteria such as Staphylococcus aureus (Staph) and Streptococcus are common causes of abscesses. I’ll remind you that MRSA stands for methicillin-resistant Staph Aureus; this is an indication that traditionally used antibiotics don’t work against this particular strain of bacteria. MRSA should be a reminder of the dangers of inappropriate antibiotic use.

How do I know if I have an abscess?
Trust me. You’ll know. Typically you’ll develop a skin infection first, which could simply include pus-filled bumps that worsen to become red, warm, swollen and tender. You may develop a fever, and you will have a significant amount of pain.
Can I treat these at home?
Generally not unless you’re a physician or have access to one at home… What you can do is prevent them. Stop picking at your skin; in fact, learn to keep your hands off your skin. Use clean equipment (e.g. razors, clippers) if you shave hair from your skin.
In terms of treating abscesses at home, it is not advisable for you to attempt to cut yourself or otherwise deal with these once one has formed. Abscesses often have deep tracks under the skin that need to be explored. Whatever you’re doing to delay getting evaluated is increasing the risk that things will worsen.

So how are abscesses treated?
There are two approaches to treating abscesses: “from the inside out” and “from the outside in.”

From the inside out refers to receiving antibiotics. Most abscess do respond promptly to antibiotics if you don’t wait too long to get them treated.
From the outside in refers to a procedure called incision and drainage (I & D). You’ll recognize this as your physician having to cut open the abscess, clean the area out and place gauze in the wound for a few days. Doing this in most cases eliminates the need to also take antibiotics. Unfortunately, I & Ds often must be done on higher risk abscesses, and in some instances, it’s necessary to have it done by a surgeon.

When should I see a doctor for one of these?
These generally aren’t getting better on their own. In particular, if you have one of the risk factors previously mentioned (diabetes, IV drug use, obesity, decreased immunity), the abscess is on or near your genitalia, is spreading fast or is extremely painful, you should be seen sooner rather than later.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Treating Your Gas and Gas Pains

September 26, 2017Diet and Nutrition, Gastrointestinal844-SMA-TALK, alpha-galactosidase, Behind the Curtain, lactase, Simethicone, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

So… you have problems with gas. What are you to do? Well, given that gas production is a natural occurrence, it’s not like you’re going to eliminate having gas (no pun intended). If you read the previous post on what produces belching and flatus, you should have a good idea as to why different things affect you the way they do. Understanding this directly leads into how you can prevent, reduce and treat untoward gas production.

I’ll make this simple. If you want to reduce the amount of gas you produce, think of these three considerations within your reach. If these efforts prove ineffective, your physician may prescribe medicine, but this should not be the initial consideration.
Adjust your diet

If you recall the variety of foods that produce gas or simply remember foods high in carbohydrates produce more gas than foods high in fat or protein, that’s a start. Unfortunately this requires thought and balance. Many healthy foods produce gas (e.g. fruits, vegetables and whole grains). You don’t want to create an unhealthy diet in pursuit of convenience. Be reminded that while fat does not cause gas to the extent that carbohydrates do, limiting high-fat foods can still help reduce bloating and discomfort. Less fat in the diet helps the stomach empty faster. This allows gases to move more quickly through the digestive system.
If you believe or know yourself to be lactose intolerant, simple avoidance of dairy products will improve your situation.

Change how you eat

Your eating habits play a role in this. For example, if you are a fast eater, you’re likely gulping down air. Slow it down, and chew more thoroughly.
Think about how you chew. Do you keep your mouth open? If so, that involves swallowing more air. Now think about those people who habitually chew gum or hard candies with their mouths open. These are habits easily altered.
Keep your dentures or dental plates adjusted so they fit. The constant production of air pockets in those loose spaces can get transmitted down your digestive track as you chew. A little attention in this direction can lead to a lot less gas. Check with your dentist.

Over-the-counter (OTC) treatments
You know certain OTC medicines well. It’s reasonable for you to know what they’re doing.

Beano (alpha-galactosidase) is a digestive aid. It helps the body digest the sugar contained within beans and many vegetables. It doesn’t affect gas production from lactose or fiber.
Mylanta, Maalox or Gas-X (simethicone) also can relieve bloating and abdominal pain or discomfort caused by gas. These products don’t affect gas production but do increase the rate of gas elimination. Thus, even when it seems as if one of these is not producing immediate relief, it’s likely helping.
Lactase tablets or drops can help people with lactose intolerance digest milk and milk products to reduce gas production. Lactose intolerance is discussed in detail in another Straight, No Chaser post.

Here’s a final word of caution. Gas pain may not be due to simple considerations. Those who burp frequently can have gastroesophageal reflux disease (GERD). Cardiac disease can present with gas pain. Irritable bowel syndrome (IBS) can be a reason why you’re more sensitive to gas pain. There are many other examples.
Remember: if these tips aren’t effective in improving your gas discomfort, please consider getting evaluated.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser in the News: Evaluating the Next Version of Trumpcare – The Graham-Cassidy Bill (Includes Numbers for Your Senator)

September 25, 2017General Health and Wellness, Public Health, Health Prevention844-SMA-TALK, ACA, Affordable Care Act, Behind the Curtain, Graham Cassidy Bill, obamacare, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

The newest effort to repeal and replace the Affordable Care Act (aka Obamacare, ACA) is called the Graham-Cassidy Bill. Although the actual legislation has been clouded in secrecy, there are a few fundamentals that can be shared, and we’ll present them in Q&A format. Be reminded that this reform is meant to impact approximately 1/6^th of the United States economy. We’ve done our best to prevent facts Straight, No Chaser style, so consider points that seem slanted self-evident truths and evaluate your reaction to them.

I. What’s a block grant? Let’s address both the facts and the spin. Block grants are a means for the federal government to cap expenses by taking a fixed amount of funds (typically what’s currently or historically being spent) and offering those same funds to individual states for their management. This isn’t a new idea. Republicans have been pushing block grants for Medicaid since the Reagan administration (1981). Block grants were notably used in converting welfare (Aid to Families with Dependent Children) away from an entitlement program in 1996. The spin (and the danger) is states would be allowed to manage those funds as they saw fit, which allows for either greater or lesser health protections, as well as innovation and restrictions. Simply put, states would be empowered to decide what services are offered and who would qualify for those services.

2. What would happen to Medicaid? In the block grant scenario, the amount would be capped with annual adjustments to account for inflation, but those amounts would not keep pace with the rate of medical inflation. In other words, states would eventually have less money with which to work. Furthermore, the proposal explicitly ends coverage for childless adults and ends the Medicaid expansion that occurred under Obamacare and currently covers 15 million adults. As such, there will be a massive redistribution away from states who opted into the ACA Medicaid expansion toward those that did not. Although the Congressional Budget Office hasn’t yet had time to score the Graham-Cassidy bill, in the past, it has opined that block grant proposals could cut Medicaid spending by as much as a third over the next decade. That’s not all. Most notoriously, the block grant would end after 2026. That’s right, in ten years the federal government would have to renew the grant, or states would need to replace every last federal dollar or roll back coverage even more. In other words, all funds currently assigned to Medicaid and the ACA would no longer be spent by the federal government in ten years under the currently proposed bill. Whether or not you believe in reducing costs, you should be quite concerned about the lack of market stability that represents, much less what’s going to happen to health care in 10 years. A conservative estimate is tens of millions of Americans will lose healthcare under any scenario of Graham-Cassidy.

3. How are preexisting conditions affected? Here’s the facts and the spin. Based on the best information available, states would be required to “offer” services to those with preexisting conditions. However, remember that services are actually provided by insurance companies. This bill neither addresses pricing nor mandates affordability to those covered. Thus, a health service could be offered, but it is probable that the price of coverage will become so high for the high-risk patient and those with preexisting conditions that they’ll either elect to or not be able to pay the cost. The nuances here allow competing interests to claim both that pre-existing conditions are or are not going to be covered.

4. Is this supported by the medical and public health communities? How about the public? Every conceivable apolitical sector, from hospitals, insurance companies, health organizations and the public are speaking out against this proposal. On Saturday, a joint press release was signed by multiple prominent medical organizations and insurance companies, united in opposition to the bill. Signing healthcare entities included the following: American Medical Association, American Academy of Family Physicians, Federation of American Hospitals, American Hospital Association, American Health Insurance Plans and the Blue Cross Blue Shield Association. Here is a quote from the press release: “While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable healthcare market that provides access to high-quality care and affordable coverage for all… The Graham-Cassidy-Heller-Johnson bill does not move us closer to that goal. The Senate should reject it.” Only 24 percent of Americans support Graham-Cassidy, according to a new poll released Thursday by Public Policy Polling. Meanwhile, the public supports retaining the Affordable Care Act over replacing it with the proposed Graham-Cassidy bill by 56-33 percent in a new ABC News/Washington Post poll.

5. What’s going on with Obamacare (Affordable Care Act/ACA) these days? It actually is very much intact, although multiple executive orders have been enacted to weaken it (that will further the appearance and reality that it is flawed). The Trump administration has reduced advertising funds by 90% to announce enrollment, but you should know enrollment for 2018 starts November 1 and ends December 15.

6. Are there any women’s health concerns? It is implicit in the effort to rollback delivery of healthcare to the states that politics will play a role in multiple issues, including those of women’s health. It is explicitly of note that the Graham-Cassidy proposal eliminates federal funding to Planned Parenthood for one year.

7. How can I express my concern? What follows is an exhaustive list of contact numbers for your Senators. Media reporting suggests the number of calls hasn’t been close to that of previous efforts to repeal the ACA, so if you have a voice to share, you have until week’s end (Friday) to be heard.

State	Senator	Office Location	Phone Number
Alabama	Strange, Luther	Birmingham	(205) 731-1500
Alabama	Strange, Luther	Huntsville	(256) 533-0979
Alabama	Strange, Luther	Mobile	(251) 414-3083
Alabama	Strange, Luther	Montgomery	(334) 230-0698
Alabama	Strange, Luther	Washington, D.C.	(202) 224-4124
Alabama	Strange, Luther	Wiregrass	(334) 792-4924
Alabama	Shelby, Richard	Birmingham	(205) 731-1384
Alabama	Shelby, Richard	Huntsville	(256) 772-0460
Alabama	Shelby, Richard	Mobile	(251) 694-4164
Alabama	Shelby, Richard	Montgomery	(334) 223-7303
Alabama	Shelby, Richard	Tuscaloosa	(205) 759-5047
Alabama	Shelby, Richard	Washington, D.C.	(202) 224-5744
Alaska	Murkowski, Lisa	Anchorage	(907) 271-3735
Alaska	Murkowski, Lisa	Fairbanks	(907) 456-0233
Alaska	Murkowski, Lisa	Juneau	(907) 586-7277
Alaska	Murkowski, Lisa	Kenai	(907) 283-5808
Alaska	Murkowski, Lisa	Ketchikan	(907) 225-6880
Alaska	Murkowski, Lisa	Mat-Su Valley	(907) 376-7665
Alaska	Murkowski, Lisa	Washington, D.C.	(202) 224-6665
Alaska	Sullivan, Dan	Anchorage	(907) 271-5915
Alaska	Sullivan, Dan	Fairbanks	(907) 456-0261
Alaska	Sullivan, Dan	Juneau	(907) 586-7277
Alaska	Sullivan, Dan	Kenai	(907) 283-4000
Alaska	Sullivan, Dan	Ketchikan	(907) 225-6880
Alaska	Sullivan, Dan	Mat-Su Valley	(907) 357-9956
Alaska	Sullivan, Dan	Washington, D.C.	(202) 224-3004
Arizona	Flake, Jeff	Phoenix	(602) 840-1891
Arizona	Flake, Jeff	Tucson	(520) 575-8633
Arizona	Flake, Jeff	Washington, D.C.	(202) 224-4521
Arizona	McCain, John	Phoenix	(602) 952-2410
Arizona	McCain, John	Prescott	(928) 445-0833
Arizona	McCain, John	Tucson	(520) 670-6334
Arizona	McCain, John	Washington, D.C.	(202) 224-2235
Arkansas	Boozman, John	El Dorado	(870) 863-4641
Arkansas	Boozman, John	Fort Smith	(479) 573-0189
Arkansas	Boozman, John	Jonesboro	(870) 268-6925
Arkansas	Boozman, John	Little Rock	(501) 372-7153
Arkansas	Boozman, John	Lowell	(479) 725-0400
Arkansas	Boozman, John	Mountain Home	(870) 424-0129
Arkansas	Boozman, John	Stuttgart	(870) 672-6941
Arkansas	Boozman, John	Washington, D.C.	(202) 224-4843
Arkansas	Cotton, Tom	El Dorado	(870) 864-8582
Arkansas	Cotton, Tom	Jonesboro	(870) 933-6223
Arkansas	Cotton, Tom	Little Rock	(501) 223-9081
Arkansas	Cotton, Tom	Springdale	(479) 751-0879
Arkansas	Cotton, Tom	Washington, D.C.	(202) 224-2353
California	Feinstein, Dianne	Fresno	(559) 485-7430
California	Feinstein, Dianne	Los Angeles	(310) 914-7300
California	Feinstein, Dianne	San Diego	(619) 231-9712
California	Feinstein, Dianne	San Francisco	(415) 393-0707
California	Feinstein, Dianne	Washington, D.C.	(202) 224-3841
California	Harris, Kamala	Fresno	(916) 448-2787
California	Harris, Kamala	Los Angeles	(213) 894-5000
California	Harris, Kamala	Sacramento	(916) 448-2787
California	Harris, Kamala	San Diego	(619) 239-3884
California	Harris, Kamala	San Francisco	(213) 894-5000
California	Harris, Kamala	Washington, D.C.	(202) 224-3553
Colorado	Bennet, Michael	Arkansas Valley	(719) 542-7550
Colorado	Bennet, Michael	Denver Metro	(303) 455-7600
Colorado	Bennet, Michael	Four Corners	(970) 259-1710
Colorado	Bennet, Michael	Northern Colorado	(970) 224-2200
Colorado	Bennet, Michael	Northwest/I-70W	(970) 241-6631
Colorado	Bennet, Michael	Pikes Peak	(719) 328-1100
Colorado	Bennet, Michael	San Luis Valley	(719) 587-0096
Colorado	Bennet, Michael	Washington, D.C.	(202) 224-5852
Colorado	Gardner, Cory	Colorado Springs	(719) 632-6706
Colorado	Gardner, Cory	Denver	(303) 391-5777
Colorado	Gardner, Cory	Fort Collins	(970) 484-3502
Colorado	Gardner, Cory	Grand Junction	(970) 245-9553
Colorado	Gardner, Cory	Greeley	(970) 352-5546
Colorado	Gardner, Cory	Pueblo	(719) 543-1324
Colorado	Gardner, Cory	Washington, D.C.	(202) 224-5941
Colorado	Gardner, Cory	Yuma	(970) 848-3095
Connecticut	Blumenthal, Richard	Bridgeport	(203) 330-0598
Connecticut	Blumenthal, Richard	Hartford	(860) 258-6940
Connecticut	Blumenthal, Richard	Washington, D.C.	(202) 224-2823
Connecticut	Murphy, Chris	Hartford	(860) 549-8463
Connecticut	Murphy, Chris	Washington, D.C.	(202) 224-4041
Delaware	Carper, Tom	Dover	(302) 674-3308
Delaware	Carper, Tom	Georgetown	(302) 856-7690
Delaware	Carper, Tom	Washington, D.C.	(202) 224-2441
Delaware	Carper, Tom	Wilmington	(302) 573-6291
Delaware	Coons, Chris	Dover	(302) 736-5601
Delaware	Coons, Chris	Washington, D.C.	(202) 224-5042
Delaware	Coons, Chris	Wilmington	(302) 573-6345
Florida	Nelson, Bill	Broward	(954) 693-4851
Florida	Nelson, Bill	Fort Myers	(239) 334-7760
Florida	Nelson, Bill	Jacksonville	(904) 346-4500
Florida	Nelson, Bill	Miami-Dade	(305) 536-5999
Florida	Nelson, Bill	Orlando	(407) 872-7161
Florida	Nelson, Bill	Tallahassee	(850) 942-8415
Florida	Nelson, Bill	Tampa	(813) 225-7040
Florida	Nelson, Bill	Washington, D.C.	(202) 224-5274
Florida	Nelson, Bill	West Palm Beach	(561) 514-0189
Florida	Rubio, Marco	Jacksonville	(904) 398-8586
Florida	Rubio, Marco	Miami	(305) 418-8553
Florida	Rubio, Marco	Naples	(239) 213-1521
Florida	Rubio, Marco	Orlando	(407) 254-2573
Florida	Rubio, Marco	Palm Beach	(561) 775-3360
Florida	Rubio, Marco	Pensacola	(850) 433-2603
Florida	Rubio, Marco	Tallahassee	(850) 599-9100
Florida	Rubio, Marco	Tampa	(813) 287-5035
Florida	Rubio, Marco	Washington, D.C.	(202) 224-3041
Georgia	Isakson, Johnny	Atlanta	(770) 661-0999
Georgia	Isakson, Johnny	Washington, D.C.	(202) 224-3643
Georgia	Perdue, David	Atlanta	(404) 865-0087
Georgia	Perdue, David	Washington, D.C.	(202) 224-3521
Hawaii	Hirono, Mazie	Hawaii	(808) 522-8970
Hawaii	Hirono, Mazie	Washington, D.C.	(202) 224-6361
Hawaii	Schatz, Brian	Honolulu	(808) 523-2061
Hawaii	Schatz, Brian	Washington, D.C.	(202) 224-3934
Idaho	Crapo, Mike	Eastern Idaho, North	(208) 522-9779
Idaho	Crapo, Mike	Eastern Idaho, South	(208) 236-6775
Idaho	Crapo, Mike	Idaho State	(208) 334-1776
Idaho	Crapo, Mike	North Idaho	(208) 664-5490
Idaho	Crapo, Mike	North-Central Idaho	(208) 743-1492
Idaho	Crapo, Mike	South-Central Idaho	(208) 734-2515
Idaho	Crapo, Mike	Washington, D.C.	(202) 224-6142
Idaho	Risch, Jim	Boise	(208) 342-7985
Idaho	Risch, Jim	Coeur D’Alene	(208) 667-6130
Idaho	Risch, Jim	Idaho Falls	(208) 523-5541
Idaho	Risch, Jim	Lewiston	(208) 743-0792
Idaho	Risch, Jim	Pocatello	(208) 236-6817
Idaho	Risch, Jim	Twin Falls	(208) 734-6780
Idaho	Risch, Jim	Washington, D.C.	(202) 224-2752
Illinois	Duckworth, Tammy	Chicago	(312) 886-3506
Illinois	Duckworth, Tammy	Washington, D.C.	(202) 224-2854
Illinois	Durbin, Richard	Carbondale	(618) 351-1122
Illinois	Durbin, Richard	Chicago	(312) 353-4952
Illinois	Durbin, Richard	Rock Island	(309) 786-5173
Illinois	Durbin, Richard	Springfield	(217) 492-4062
Illinois	Durbin, Richard	Washington, D.C.	(202) 224-2152
Indiana	Donnelly, Joe	Evansville	(812) 425-5813
Indiana	Donnelly, Joe	Fort Wayne	(260) 420-4955
Indiana	Donnelly, Joe	Hammond	(219) 852-0089
Indiana	Donnelly, Joe	Indianapolis	(317) 226-5555
Indiana	Donnelly, Joe	Jeffersonville	(812) 284-2027
Indiana	Donnelly, Joe	South Bend	(574) 288-2780
Indiana	Donnelly, Joe	Washington, D.C.	(202) 224-4814
Indiana	Young, Todd	Evansville
Indiana	Young, Todd	Fort Wayne
Indiana	Young, Todd	Indianapolis	(317) 226-6700
Indiana	Young, Todd	New Albany	(812) 542-4820
Indiana	Young, Todd	Washington, D.C.	(202) 224-5623
Iowa	Ernst, Joni	Cedar Rapids	(319) 365-4504
Iowa	Ernst, Joni	Council Bluffs	(712) 352-1167
Iowa	Ernst, Joni	Davenport	(563) 322-0677
Iowa	Ernst, Joni	Des Moines	(515) 284-4574
Iowa	Ernst, Joni	Sioux City	(712) 252-1550
Iowa	Ernst, Joni	Washington, D.C.	(202) 224-3254
Iowa	Grassley, Chuck	Cedar Rapids	(319) 363-6832
Iowa	Grassley, Chuck	Council Bluffs	(712) 322-7103
Iowa	Grassley, Chuck	Davenport	(563) 322-4331
Iowa	Grassley, Chuck	Des Moines	(515) 288-1145
Iowa	Grassley, Chuck	Sioux City	(712) 233-1860
Iowa	Grassley, Chuck	Washington, D.C.	(202) 224-3744
Iowa	Grassley, Chuck	Waterloo	(319) 232-6657
Kansas	Moran, Jerry	Hays	(785) 628-6401
Kansas	Moran, Jerry	Manhattan	(785) 539-8973
Kansas	Moran, Jerry	Olathe	(913) 393-0711
Kansas	Moran, Jerry	Pittsburg	(620) 232-2286
Kansas	Moran, Jerry	Washington, D.C.	(202) 224-6521
Kansas	Moran, Jerry	Wichita	(316) 631-1410
Kansas	Roberts, Pat	Dodge City	(620) 227-2244
Kansas	Roberts, Pat	Overland Park	(913) 451-9343
Kansas	Roberts, Pat	Topeka	(785) 295-2745
Kansas	Roberts, Pat	Washington, D.C.	(202) 224-4774
Kansas	Roberts, Pat	Wichita	(316) 263-0416
Kentucky	McConnell, Mitch	Bowling Green	(270) 781-1673
Kentucky	McConnell, Mitch	Ft. Wright	(859) 578-0188
Kentucky	McConnell, Mitch	Lexington	(859) 224-8286
Kentucky	McConnell, Mitch	London	(606) 864-2026
Kentucky	McConnell, Mitch	Louisville	(502) 582-6304
Kentucky	McConnell, Mitch	Paducah	(270) 442-4554
Kentucky	McConnell, Mitch	Washington, D.C.	(202) 224-2541
Kentucky	Paul, Rand	Bowling Green	(270) 782-8303
Kentucky	Paul, Rand	Crescent Springs	(859) 426-0165
Kentucky	Paul, Rand	Hopkinsville	(270) 885-1212
Kentucky	Paul, Rand	Lexington	(859) 219-2239
Kentucky	Paul, Rand	Louisville	(502) 582-5341
Kentucky	Paul, Rand	Owensboro	(270) 689-9085
Kentucky	Paul, Rand	Washington, D.C.	(202) 224-4343
Lousiana	Cassidy, Bill	Alexandria	(318) 448-7176
Lousiana	Cassidy, Bill	Baton Rouge	(225) 929-7711
Lousiana	Cassidy, Bill	Lafayette	(337) 261-1400
Lousiana	Cassidy, Bill	Lake Charles	(337) 493-5398
Lousiana	Cassidy, Bill	Metairie	(504) 838-0130
Lousiana	Cassidy, Bill	Monroe	(318) 324-2111
Lousiana	Cassidy, Bill	Shreveport	(318) 798-3215
Lousiana	Cassidy, Bill	Washington, D.C.	(202) 224-5824
Lousiana	Kennedy, John	Washington, D.C.	(202) 224-4623
Maine	Collins, Susan	Augusta	(207) 622-8414
Maine	Collins, Susan	Bangor	(207) 945-0417
Maine	Collins, Susan	Biddeford	(207) 283-1101
Maine	Collins, Susan	Caribou	(207) 493-7873
Maine	Collins, Susan	Lewiston	(207) 784-6969
Maine	Collins, Susan	Portland	(207) 780-3575
Maine	Collins, Susan	Washington, D.C.	(202) 224-2523
Maine	King, Angus	Augusta	(207) 622-8292
Maine	King, Angus	Bangor	(207) 945-8000
Maine	King, Angus	Presque Isle	(207) 764-5124
Maine	King, Angus	Scarborough	(207) 883-1588
Maine	King, Angus	Washington, D.C.	(202) 224-5344
Maryland	Cardin, Ben	Baltimore	(410) 962-4436
Maryland	Cardin, Ben	Bowie	(301) 860-0414
Maryland	Cardin, Ben	Cumberland	(301) 777-2957
Maryland	Cardin, Ben	Rockville	(301) 762-2974
Maryland	Cardin, Ben	Salisbury	(410) 546-4250
Maryland	Cardin, Ben	Southern Maryland	(202) 870-1164
Maryland	Cardin, Ben	Washington, D.C.	(202) 224-4524
Maryland	Van Hollen, Chris	Washington, D.C.	(202) 224-4654
Massachusetts	Markey, Ed	Boston	(617) 565-8519
Massachusetts	Markey, Ed	Fall River	(508) 677-0523
Massachusetts	Markey, Ed	Springfield	(413) 785-4610
Massachusetts	Markey, Ed	Washington, D.C.	(202) 224-2742
Massachusetts	Warren, Elizabeth	Boston	(617) 565-3170
Massachusetts	Warren, Elizabeth	Springfield	(413) 788-2690
Massachusetts	Warren, Elizabeth	Washington, D.C.	(202) 224-4543
Michigan	Peters, Gary	Detroit	(313) 226-6020
Michigan	Peters, Gary	Grand Rapids	(616) 233-9150
Michigan	Peters, Gary	Lansing	(517) 377-1508
Michigan	Peters, Gary	Marquette	(906) 226-4554
Michigan	Peters, Gary	Rochester	(248) 608-8040
Michigan	Peters, Gary	Saginaw	(989) 754-0112
Michigan	Peters, Gary	Traverse City	(231) 947-7773
Michigan	Peters, Gary	Washington, D.C.	(202) 224-6221
Michigan	Stabenow, Debbie	Flint/Saginaw Bay	(810) 720-4172
Michigan	Stabenow, Debbie	Mid-Michigan	(517) 203-1760
Michigan	Stabenow, Debbie	Northern Michigan	(231) 929-1031
Michigan	Stabenow, Debbie	Southeast Michigan	(313) 961-4330
Michigan	Stabenow, Debbie	Upper Peninsula	(906) 228-8756
Michigan	Stabenow, Debbie	Washington, D.C.	(202) 224-4822
Michigan	Stabenow, Debbie	West Michigan	(616) 975-0052
Minnesota	Franken, Al	Duluth	(218) 722-2390
Minnesota	Franken, Al	Moorhead	(218) 284-8721
Minnesota	Franken, Al	Rochester	(507) 288-2003
Minnesota	Franken, Al	Saint Paul	(651) 221-1016
Minnesota	Franken, Al	Washington, D.C.	(202) 224-5641
Minnesota	Klobuchar, Amy	Metro	(612) 727-5220
Minnesota	Klobuchar, Amy	Northeastern	(218) 741-9690
Minnesota	Klobuchar, Amy	Northwestern & Central	(218) 287-2219
Minnesota	Klobuchar, Amy	Southern	(507) 288-5321
Minnesota	Klobuchar, Amy	Washington, D.C.	(202) 224-3244
Mississippi	Cochran, Thad	Gulf Coast	(228) 867-9710
Mississippi	Cochran, Thad	Jackson	(601) 965-4459
Mississippi	Cochran, Thad	Oxford	(662) 236-1018
Mississippi	Cochran, Thad	Washington, D.C.	(202) 224-5054
Mississippi	Wicker, Roger	Gulfport	(228) 871-7017
Mississippi	Wicker, Roger	Hernando	(662) 429-1002
Mississippi	Wicker, Roger	Jackson	(601) 965-4644
Mississippi	Wicker, Roger	Tupelo	(662) 844-5010
Mississippi	Wicker, Roger	Washington, D.C.	(202) 224-6253
Missouri	Blunt, Roy	Cape Girardeau	(573) 334-7044
Missouri	Blunt, Roy	Columbia	(573) 442-8151
Missouri	Blunt, Roy	Kansas City	(816) 471-7141
Missouri	Blunt, Roy	Springfield	(417) 877-7814
Missouri	Blunt, Roy	St. Louis/Clayton	(314) 725-4484
Missouri	Blunt, Roy	Washington, D.C.	(202) 224-5721
Missouri	McCaskill, Claire	Cape Girardeau	(573) 651-0964
Missouri	McCaskill, Claire	Columbia	(573) 442-7130
Missouri	McCaskill, Claire	Kansas City	(816) 421-1639
Missouri	McCaskill, Claire	Springfield	(417) 868-8745
Missouri	McCaskill, Claire	St. Louis	(314) 367-1364
Missouri	McCaskill, Claire	Washington, D.C.	(202) 224-6154
Montana	Daines, Steve	Billings	(406) 245-6822
Montana	Daines, Steve	Bozeman	(406) 587-3446
Montana	Daines, Steve	Great Falls	(406) 453-0148
Montana	Daines, Steve	Hardin	(406) 665-4126
Montana	Daines, Steve	Helena	(406) 443-3189
Montana	Daines, Steve	Kalispell	(406) 257-3765
Montana	Daines, Steve	Missoula	(406) 549-8198
Montana	Daines, Steve	Sidney	(406) 482-9010
Montana	Daines, Steve	Washington, D.C.	(202) 224-2651
Montana	Tester, Jon	Billings	(406) 252-0550
Montana	Tester, Jon	Bozeman	(406) 586-4450
Montana	Tester, Jon	Butte	(406) 723-3277
Montana	Tester, Jon	Glendive	(406) 365-2391
Montana	Tester, Jon	Great Falls	(406) 452-9585
Montana	Tester, Jon	Helena	(406) 449-5401
Montana	Tester, Jon	Kalispell	(406) 257-3360
Montana	Tester, Jon	Missoula	(406) 728-3003
Montana	Tester, Jon	Washington, D.C.	(202) 224-2644
Nebraska	Fischer, Deb	Kearney	(308) 234-2361
Nebraska	Fischer, Deb	Lincoln	(402) 441-4600
Nebraska	Fischer, Deb	Norfolk	(402) 200-8816
Nebraska	Fischer, Deb	Omaha	(402) 391-3411
Nebraska	Fischer, Deb	Scottsbluff	(308) 630-2329
Nebraska	Fischer, Deb	Washington, D.C.	(202) 224-6551
Nebraska	Sasse, Ben	Kearney	(308) 233-3677
Nebraska	Sasse, Ben	Lincoln	(402) 476-1400
Nebraska	Sasse, Ben	Omaha	(402) 550-8040
Nebraska	Sasse, Ben	Scottsbluff	(308) 632-6032
Nebraska	Sasse, Ben	Washington, D.C.	(202) 224-4224
Nevada	Cortez Masto, Catherine	Las Vegas	(702) 388-5020
Nevada	Cortez Masto, Catherine	Reno	(775) 686-5750
Nevada	Cortez Masto, Catherine	Washington, D.C.	(202) 224-3542
Nevada	Heller, Dean	Las Vegas	(702) 388-6605
Nevada	Heller, Dean	Reno	(775) 686-5770
Nevada	Heller, Dean	Washington, D.C.	(202) 224-6244
New Hampshire	Hassan, Maggie	Manchester	(603) 622-2204
New Hampshire	Hassan, Maggie	Washington, D.C.	(202) 224-3324
New Hampshire	Shaheen, Jeanne	Berlin	(603) 752-6300
New Hampshire	Shaheen, Jeanne	Claremont	(603) 542-4872
New Hampshire	Shaheen, Jeanne	Dover	(603) 750-3004
New Hampshire	Shaheen, Jeanne	Keene	(603) 358-6604
New Hampshire	Shaheen, Jeanne	Manchester	(603) 647-7500
New Hampshire	Shaheen, Jeanne	Nashua	(603) 883-0196
New Hampshire	Shaheen, Jeanne	Washington, D.C.	(202) 224-2841
New Jersey	Booker, Cory	Camden	(856) 338-8922
New Jersey	Booker, Cory	Newark	(973) 639-8700
New Jersey	Booker, Cory	Washington, D.C.	(202) 224-3224
New Jersey	Menendez, Bob	Barrington	(856) 757-5353
New Jersey	Menendez, Bob	Newark	(973) 645-3030
New Jersey	Menendez, Bob	Washington, D.C.	(202) 224-4744
New Mexico	Heinrich, Martin	Albuquerque	(505) 346-6601
New Mexico	Heinrich, Martin	Farmington	(505) 325-5030
New Mexico	Heinrich, Martin	Las Cruces	(575) 523-6561
New Mexico	Heinrich, Martin	Roswell	(575) 622-7113
New Mexico	Heinrich, Martin	Santa Fe	(505) 988-6647
New Mexico	Heinrich, Martin	Washington, D.C.	(202) 224-5521
New Mexico	Udall, Tom	Albuquerque	(505) 346-6791
New Mexico	Udall, Tom	Carlsbad	(575) 234-0366
New Mexico	Udall, Tom	Eastside	(575) 356-6811
New Mexico	Udall, Tom	Las Cruces	(575) 526-5475
New Mexico	Udall, Tom	Santa Fe	(505) 988-6511
New Mexico	Udall, Tom	Washington, D.C.	(202) 224-6621
New York	Gillibrand, Kirsten	Albany	(518) 431-0120
New York	Gillibrand, Kirsten	Buffalo	(716) 854-9725
New York	Gillibrand, Kirsten	Hudson Valley	(845) 875-4585
New York	Gillibrand, Kirsten	Long Island	(631) 249-2825
New York	Gillibrand, Kirsten	New York City	(212) 688-6262
New York	Gillibrand, Kirsten	North Country	(315) 376-6118
New York	Gillibrand, Kirsten	Rochester	(585) 263-6250
New York	Gillibrand, Kirsten	Syracuse	(315) 448-0470
New York	Gillibrand, Kirsten	Washington, D.C.	(202) 224-4451
New York	Schumer, Chuck	Albany	(518) 431-4070
New York	Schumer, Chuck	Binghamton	(607) 772-6792
New York	Schumer, Chuck	Buffalo	(716) 846-4111
New York	Schumer, Chuck	Melville	(631) 753-0978
New York	Schumer, Chuck	New York City	(212) 486-4430
New York	Schumer, Chuck	Peekskill	(914) 734-1532
New York	Schumer, Chuck	Rochester	(585) 263-5866
New York	Schumer, Chuck	Syracuse	(315) 423-5471
New York	Schumer, Chuck	Washington, D.C.	(202) 224-6542
North Carolina	Burr, Richard	Asheville	(828) 350-2437
North Carolina	Burr, Richard	Gastonia	(704) 833-0854
North Carolina	Burr, Richard	Rocky Mount	(252) 977-9522
North Carolina	Burr, Richard	Washington, D.C.	(202) 224-3154
North Carolina	Burr, Richard	Wilmington	(910) 251-1058
North Carolina	Burr, Richard	Winston-Salem	(336) 631-5125
North Carolina	Tillis, Thom	Charlotte	(704) 509-9087
North Carolina	Tillis, Thom	Greenville	(252) 329-0371
North Carolina	Tillis, Thom	Hendersonville	(828) 693-8750
North Carolina	Tillis, Thom	High Point	(336) 885-0685
North Carolina	Tillis, Thom	Raleigh	(919) 856-4630
North Carolina	Tillis, Thom	Washington, D.C.	(202) 224-6342
North Dakota	Heitkamp, Heidi	Bismarck	(701) 258-4648
North Dakota	Heitkamp, Heidi	Dickinson	(701) 225-0974
North Dakota	Heitkamp, Heidi	Fargo	(701) 232-8030
North Dakota	Heitkamp, Heidi	Grand Forks	(701) 775-9601
North Dakota	Heitkamp, Heidi	Minot	(701) 852-0703
North Dakota	Heitkamp, Heidi	Washington, D.C.	(202) 224-2043
North Dakota	Hoeven, John	Bismarck	(701) 250-4618
North Dakota	Hoeven, John	Fargo	(701) 239-5389
North Dakota	Hoeven, John	Grand Forks	(701) 746-8972
North Dakota	Hoeven, John	Minot	(701) 838-1361
North Dakota	Hoeven, John	Washington, D.C.	(202) 224-2551
North Dakota	Hoeven, John	Western North Dakota	(701) 580-4535
Ohio	Brown, Sherrod	Cincinnati	(513) 684-1021
Ohio	Brown, Sherrod	Cleveland	(216) 522-7272
Ohio	Brown, Sherrod	Columbus	(614) 469-2083
Ohio	Brown, Sherrod	Lorain	(440) 242-4100
Ohio	Brown, Sherrod	Washington, D.C.	(202) 224-2315
Ohio	Portman, Rob	Cincinnati	(513) 684-3265
Ohio	Portman, Rob	Cleveland	(216) 522-7095
Ohio	Portman, Rob	Columbus	(614) 469-6774
Ohio	Portman, Rob	Toledo	(419) 259-3895
Ohio	Portman, Rob	Washington, D.C.	(202) 224-3353
Oklahoma	Inhofe, Jim	Enid	(580) 234-5105
Oklahoma	Inhofe, Jim	McAlester	(918) 426-0933
Oklahoma	Inhofe, Jim	Oklahoma City	(405) 608-4381
Oklahoma	Inhofe, Jim	Tulsa	(918) 748-5111
Oklahoma	Inhofe, Jim	Washington, D.C.	(202) 224-4721
Oklahoma	Lankford, James	Oklahoma City	(405) 231-4941
Oklahoma	Lankford, James	Tulsa	(918) 581-7651
Oklahoma	Lankford, James	Washington, D.C.	(202) 224-5754
Oregon	Merkley, Jeff	Bend	(541) 318-1298
Oregon	Merkley, Jeff	Eugene	(541) 465-6750
Oregon	Merkley, Jeff	Medford	(541) 608-9102
Oregon	Merkley, Jeff	Pendleton	(541) 278-1129
Oregon	Merkley, Jeff	Portland	(503) 326-3386
Oregon	Merkley, Jeff	Salem	(503) 362-8102
Oregon	Merkley, Jeff	Washington, D.C.	(202) 224-3753
Oregon	Wyden, Ron	Bend	(541) 330-9142
Oregon	Wyden, Ron	Eugene	(541) 431-0229
Oregon	Wyden, Ron	La Grande	(541) 962-7691
Oregon	Wyden, Ron	Medford	(541) 858-5122
Oregon	Wyden, Ron	Portland	(503) 326-7525
Oregon	Wyden, Ron	Salem	(503) 589-4555
Oregon	Wyden, Ron	Washington, D.C.	(202) 224-5244
Pennsylvania	Casey, Bob	Central Pa	(814) 357-0314
Pennsylvania	Casey, Bob	Erie	(814) 874-5080
Pennsylvania	Casey, Bob	Harrisburg	(717) 231-7540
Pennsylvania	Casey, Bob	Lehigh Valley	(610) 782-9470
Pennsylvania	Casey, Bob	Northeastern	(570) 941-0930
Pennsylvania	Casey, Bob	Philadelphia	(215) 405-9660
Pennsylvania	Casey, Bob	Pittsburgh	(412) 803-7370
Pennsylvania	Casey, Bob	Washington, D.C.	(202) 224-6324
Pennsylvania	Toomey, Pat	Allentown/Lehigh Valley	(610) 434-1444
Pennsylvania	Toomey, Pat	Erie	(814) 453-3010
Pennsylvania	Toomey, Pat	Harrisburg	(717) 782-3951
Pennsylvania	Toomey, Pat	Johnstown	(814) 266-5970
Pennsylvania	Toomey, Pat	Philadelphia	(215) 241-1090
Pennsylvania	Toomey, Pat	Pittsburgh	(412) 803-3501
Pennsylvania	Toomey, Pat	Scranton	(570) 941-3540
Pennsylvania	Toomey, Pat	Washington, D.C.	(202) 224-4254
Rhode Island	Reed, Jack	Cranston	(401) 943-3100
Rhode Island	Reed, Jack	Providence	(401) 528-5200
Rhode Island	Reed, Jack	Washington, D.C.	(202) 224-4642
Rhode Island	Whitehouse, Sheldon	Providence	(401) 453-5294
Rhode Island	Whitehouse, Sheldon	Washington, D.C.	(202) 224-2921
South Carolina	Graham, Lindsey	Golden Corner	(864) 646-4090
South Carolina	Graham, Lindsey	Lowcountry	(843) 849-3887
South Carolina	Graham, Lindsey	Midlands	(803) 933-0112
South Carolina	Graham, Lindsey	Pee Dee	(843) 669-1505
South Carolina	Graham, Lindsey	Piedmont	(803) 366-2828
South Carolina	Graham, Lindsey	Upstate	(864) 250-1417
South Carolina	Graham, Lindsey	Washington, D.C.	(202) 224-5972
South Carolina	Scott, Tim	Lowcountry	(843) 727-4525
South Carolina	Scott, Tim	Midlands	(803) 771-6112
South Carolina	Scott, Tim	Upstate	(864) 233-5366
South Carolina	Scott, Tim	Washington, D.C.	(202) 224-6121
South Dakota	Rounds, Mike	Aberdeen	(605) 225-0366
South Dakota	Rounds, Mike	Pierre	(605) 224-1450
South Dakota	Rounds, Mike	Rapid City	(605) 343-5035
South Dakota	Rounds, Mike	Sioux Falls	(605) 336-0486
South Dakota	Rounds, Mike	Washington, D.C.	(202) 224-5842
South Dakota	Thune, John	Aberdeen	(605) 225-8823
South Dakota	Thune, John	Rapid City	(605) 348-7551
South Dakota	Thune, John	Sioux Falls	(605) 334-9596
South Dakota	Thune, John	Washington, D.C.	(202) 224-2321
Tennessee	Alexander, Lamar	Chattanooga	(423) 752-5337
Tennessee	Alexander, Lamar	Jackson	(731) 664-0289
Tennessee	Alexander, Lamar	Knoxville	(865) 545-4253
Tennessee	Alexander, Lamar	Memphis	(901) 544-4224
Tennessee	Alexander, Lamar	Nashville	(615) 736-5129
Tennessee	Alexander, Lamar	Tri-Cities	(423) 325-6240
Tennessee	Alexander, Lamar	Washington, D.C.	(202) 224-4944
Tennessee	Corker, Bob	Chattanooga	(423) 756-2757
Tennessee	Corker, Bob	Jackson	(731) 664-2294
Tennessee	Corker, Bob	Knoxville	(865) 637-4180
Tennessee	Corker, Bob	Memphis	(901) 683-1910
Tennessee	Corker, Bob	Nashville	(615) 279-8125
Tennessee	Corker, Bob	Tri-Cities	(423) 753-2263
Tennessee	Corker, Bob	Washington, D.C.	(202) 224-3344
Texas	Cornyn, John	Central Texas	(512) 469-6034
Texas	Cornyn, John	East Texas	(903) 593-0902
Texas	Cornyn, John	North Texas	(972) 239-1310
Texas	Cornyn, John	South Central Texas	(210) 224-7485
Texas	Cornyn, John	South Texas	(956) 423-0162
Texas	Cornyn, John	Southeast Texas	(713) 572-3337
Texas	Cornyn, John	Washington, D.C.	(202) 224-2934
Texas	Cornyn, John	West Texas	(806) 472-7533
Texas	Cruz, Ted	Central Texas	(512) 916-5834
Texas	Cruz, Ted	East Texas	(903) 593-5130
Texas	Cruz, Ted	North Texas	(214) 599-8749
Texas	Cruz, Ted	South Texas	(956) 686-7339
Texas	Cruz, Ted	South/Central Texas	(210) 340-2885
Texas	Cruz, Ted	Southeast Texas	(713) 718-3057
Texas	Cruz, Ted	Washington, D.C.	(202) 224-5922
Utah	Hatch, Orrin	Cedar City	(435) 586-8435
Utah	Hatch, Orrin	Ogden	(801) 625-5672
Utah	Hatch, Orrin	Provo	(801) 375-7881
Utah	Hatch, Orrin	Salt Lake City	(801) 524-4380
Utah	Hatch, Orrin	St. George	(435) 634-1795
Utah	Hatch, Orrin	Washington, D.C.	(202) 224-5251
Utah	Lee, Mike	Ogden	(801) 392-9633
Utah	Lee, Mike	Salt Lake City	(801) 524-5933
Utah	Lee, Mike	St. George	(435) 628-5514
Utah	Lee, Mike	Washington, D.C.	(202) 224-5444
Vermont	Leahy, Patrick	Burlington	(802) 863-2525
Vermont	Leahy, Patrick	Montpelier	(802) 229-0569
Vermont	Leahy, Patrick	Washington, D.C.	(202) 224-4242
Vermont	Sanders, Bernie	Burlington	(802) 862-0697
Vermont	Sanders, Bernie	St. Johnsbury	(802) 748-9269
Vermont	Sanders, Bernie	Washington, D.C.	(202) 224-5141
Virginia	Kaine, Tim	Abingdon	(276) 525-4790
Virginia	Kaine, Tim	Manassas	(703) 361-3192
Virginia	Kaine, Tim	Richmond	(804) 771-2221
Virginia	Kaine, Tim	Roanoke	(540) 682-5693
Virginia	Kaine, Tim	Virginia Beach	(757) 518-1674
Virginia	Kaine, Tim	Washington, D.C.	(202) 224-4024
Virginia	Kaine, Tim	Washington, D.C.	(202) 224-4024
Virginia	Warner, Mark	Abingdon	(276) 628-8158
Virginia	Warner, Mark	Norfolk	(757) 441-3079
Virginia	Warner, Mark	Richmond	(804) 775-2314
Virginia	Warner, Mark	Roanoke	(540) 857-2676
Virginia	Warner, Mark	Vienna	(703) 442-0670
Virginia	Warner, Mark	Washington, D.C.	(202) 224-2023
Washington	Cantwell, Maria	Everett	(425) 303-0114
Washington	Cantwell, Maria	Richland	(509) 946-8106
Washington	Cantwell, Maria	Seattle	(206) 220-6400
Washington	Cantwell, Maria	Spokane	(509) 353-2507
Washington	Cantwell, Maria	Tacoma	(253) 572-2281
Washington	Cantwell, Maria	Vancouver	(360) 696-7838
Washington	Cantwell, Maria	Washington, D.C.	(202) 224-3441
Washington	Murray, Patty	Everett	(425) 259-6515
Washington	Murray, Patty	Seattle	(206) 553-5545
Washington	Murray, Patty	Spokane	(509) 624-9515
Washington	Murray, Patty	Tacoma	(253) 572-3636
Washington	Murray, Patty	Vancouver	(360) 696-7797
Washington	Murray, Patty	Washington, D.C.	(202) 224-2621
Washington	Murray, Patty	Yakima	(509) 453-7462
West Virginia	Capito, Shelley Moore	Beckley	(304) 347-5372
West Virginia	Capito, Shelley Moore	Charleston	(304) 347-5372
West Virginia	Capito, Shelley Moore	Martinsburg	(304) 262-9285
West Virginia	Capito, Shelley Moore	Morgantown	(304) 292-2310
West Virginia	Capito, Shelley Moore	Washington, D.C.	(202) 224-6472
West Virginia	Manchin, Joe	Charleston	(304) 342-5855
West Virginia	Manchin, Joe	Eastern Panhandle	(304) 264-4626
West Virginia	Manchin, Joe	Fairmont	(304) 368-0567
West Virginia	Manchin, Joe	Washington, D.C.	(202) 224-3954
Wisconsin	Baldwin, Tammy	Eau Claire	(715) 832-8424
Wisconsin	Baldwin, Tammy	Green Bay	(920) 498-2668
Wisconsin	Baldwin, Tammy	La Crosse	(608) 796-0045
Wisconsin	Baldwin, Tammy	Madison	(608) 264-5338
Wisconsin	Baldwin, Tammy	Milwaukee	(414) 297-4451
Wisconsin	Baldwin, Tammy	Washington, D.C.	(202) 224-5653
Wisconsin	Baldwin, Tammy	Wausau	(715) 261-2611
Wisconsin	Johnson, Ron	Milwaukee	(414) 276-7282
Wisconsin	Johnson, Ron	Oshkosh	(920) 230-7250
Wisconsin	Johnson, Ron	Washington, D.C.	(202) 224-5323
Wyoming	Barrasso, John	Casper	(307) 261-6413
Wyoming	Barrasso, John	Cheyenne	(307) 772-2451
Wyoming	Barrasso, John	Riverton	(307) 856-6642
Wyoming	Barrasso, John	Rock Springs	(307) 362-5012
Wyoming	Barrasso, John	Sheridan	(307) 672-6456
Wyoming	Barrasso, John	Washington, D.C.	(202) 224-6441
Wyoming	Enzi, Michael	Casper	(307) 261-6572
Wyoming	Enzi, Michael	Cheyenne	(307) 772-2477
Wyoming	Enzi, Michael	Cody	(307) 527-9444
Wyoming	Enzi, Michael	Gillette	(307) 682-6268
Wyoming	Enzi, Michael	Jackson	(307) 739-9507
Wyoming	Enzi, Michael	Washington, D.C.	(202) 224-3424

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Eructation (Belching) and Flatus (The Other One)

September 25, 2017Gastrointestinal844-SMA-TALK, Behind the Curtain, belching, carbon dioxide, eructation, flatus, methane gas, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

It seems like Straight, No Chaser is unafraid to address any topic! This, here’s one of those conversations that everyone wants to have but rarely does. Gas is a natural phenomenon. That’s a given. However, all of us probably want to and would benefit from knowing why it’s happening and what can be done to minimize those odoriferous emanations from above and below. Here are some frequently asked questions on the gas you pass.

What is gas?
Gas is a byproduct of the digestive process or of your swallowing air. It’s some combination of oxygen, carbon dioxide, hydrogen, nitrogen and methane gases. Remember the digestive tract extends from your mouth to your anus, so depending on where the gas is produced, the gas may be expressed from either end of you through burps or flatus.
Why would I swallow air?
Everyone swallows a small amount of air when eating and drinking. The amount of air swallowed increases when people eat or drink too fast, chew gum or suck or hard candy, drink carbonated beverages, smoke or wear loose-fitting dentures.

Why does gas have that smell?
Flatus (gas passed through the anus) may contain small amounts of sulfur. Flatus that contains more sulfur gasses has more odor.
Why do I produce so much gas?

Passing gas is normal. In fact, the average person does so about 15-20 times a day. Many things can cause you to produce more, including eating a lot of carbohydrates (e.g. sugars, starches, fibers). The upper parts of the digestive system (stomach and small intestines) are as effective as the lower intestines as breaking down carbohydrates. When the lower intestines do so, gases including hydrogen, carbon dioxide, methane gas or hydrogen sulfide (a sulfur gas – as mentioned, methane and sulfur as more noticeably smelly gases). This isn’t as much of an issue with fat and protein based diets.
Constipation also results in increased amounts of methane production.
Conditions that disrupt the digestive system can have the same effect. Examples include diabetes and Crohn’s disease.

Can you give examples of foods that are carbohydrates and cause gas?
There’s wide variation between individuals in how foods are digested. As an example, consider the effect of being lactose intolerant. Some foods that may cause gas include

fruits such as pears, apples, and peaches
vegetables such as broccoli, cauliflower, cabbage, Brussels sprouts, onions, mushrooms, artichokes, and asparagus
whole grains such as whole wheat and bran
sodas; fruit drinks, especially apple juice and pear juice; and other drinks that contain high-fructose corn syrup, a sweetener made from corn
beans
milk and milk products such as cheese, ice cream, and yogurt
packaged foods—such as bread, cereal, and salad dressing—that contain small amounts of lactose, a sugar found in milk and foods made with milk
sugar-free candies and gums that contain sugar alcohols such as sorbitol, mannitol, and xylitol

What are the symptoms of gas?
In addition to burping and passing gas, bloating and abdominal discomfort are common.
When should I be seen for gas?
It’s easy to be distracted by what you believe to be simple gas pains. If your symptoms are new or different (especially if you’re above age 40), or if your gas symptoms are accompanied by diarrhea, constipation or weight loss, you should get evaluated. Of course, severe pain seems to be the most common prompt for an evaluation.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Fall Prevention

September 24, 2017Geriatrics/Elderly Care, Orthopedics/Bones844-SMA-TALK, Behind the Curtain, fall prevention, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

We’ve missed the first day of Fall by a few days, but for all of you DIYers (do it yourself) ready for a weekend project to help a loved one, here you go. The beginning of Fall is a good time to discuss fall prevention among the elderly. First, let’s start with some not so fun facts.

Every year, one of every three adults older than 65 has a fall.
Falls are the #1 cause of injury death in senior citizens.
Falls are the #1 cause of nonfatal injuries and trauma hospitalizations.
Typical injuries include lacerations, hip fractures and head injuries (including intracranial bleeds). These injuries occur in approximately 20-30% of falls.

How can older adults prevent falls and the complications of falls? Here are six Quick Tips I hope you’ll share with your loved ones.

Start by doing some home improvements to accommodate the shortcomings of your elderly relatives. Consider railings and grab bars – near the bed, on the stairways, shower, tub and toilet. Improve lighting. Clear out and widen walking paths. Consider using a walker.
Exercise regularly. It keeps the brain sharp and the leg muscles strong. Inactivity promotes bad outcomes when activity is attempted. Have their doctors arrange for home health care and physical therapy if indicated.

Have your loved one and your family review medications with their physician. You need to know which medications and drug interactions can promote loss of balance, dizziness, drowsiness, and/or mental status changes, all of which can lead to falls.
Keep those eyes checked. This should be happening at least once a year. Be diligent in changing prescriptions as needed. Could you imagine being a little confused and not being able to see? What would you expect to happen?

Pay attention to diet. Nutritional needs are even greater in those with health issues, which is always the case in the elderly. Supplement Vitamin D and calcium for bone strength.
Of course, get screened and, if needed, treated for osteoporosis.

The key is to pay attention. You don’t have to let your loved ones wither into oblivion. Simple quick fixes and some love and attention can go a long way to preventing falls and the injuries that accompany them. Good luck.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Prostate Cancer Screening

September 23, 2017General Health and Wellness844-SMA-TALK, American Cancer Society, Behind the Curtain, digital rectal exam, Prostate cancer, prostate cancer screening, Prostate-specific antigen, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Every so often, controversies regarding medical treatment recommendations get in the news and seemingly only serve to confuse the public. Every blog, article or research paper is a single entity that may or may not adjust the body and weight of evidence on a given topic. Even most well-done research articles do not completely change the standard of care for medical practice. Prostate cancer screening is a great example. At the end of it all, controversies aren’t as important as the consensus recommendations that emerge from medical and public health professionals tasked with reviewing such information.
In this Straight, No Chaser, we will review the 2015 recommendations from the American Cancer Society (ACS) for early detection of prostate cancer. Remember, when you hear dissenting views, consider the source and balance that against the formal recommendations of ACS.
In an earlier Straight, No Chaser, several questions regarding prostate cancer were addressed. However, there is one additional question that is important to review.
Does Everyone With Prostate Cancer Get Treated?

This is the source of controversies regarding screening of prostate cancer. Most men diagnosed with prostate cancer do not die from the disease. I mentioned previously that 30,000 men with prostate cancer die of the disease every year. However, over 2.5 million men in the U.S. are currently living with a diagnosis of prostate cancer. Based on these statistics, the question then becomes…

Why Do All Men Need to Be Screened For Prostate Cancer?
A certain stream of logic asks why screening is necessary if most of those who are diagnosed don’t die. Many treatments (e.g. surgery, medications, radiation) have additional risks that could be avoided if interventions were avoided. Similarly, some have taken to asking if any screening program is necessary. The view here is information is empowering. It’s always better to have information regarding the state of your health. Working with your medical team and family, the correct decisions about next steps can be made. This option is only available if you know what’s happening with your health.
How Does Screening Occur?

There are two tests commonly used to screen for prostate cancer.

A digital rectal exam (DRE) is when a doctor inserts a gloved, lubricated finger into the rectum and estimates the size of the prostate and assesses it for lumps or other abnormalities.
The prostate specific antigen (PSA) test measures the level of PSA in the blood. PSA is a substance made by the prostate, and PSA blood levels can be higher in men who have prostate cancer. Unfortunately the PSA level isn’t specific for prostate cancer, as it can be elevated in other conditions that affect the prostate such as age, race, certain medications or medical procedures, prostate enlargement or infection.

So What Are The Current Recommendations for screening?

The American Cancer Society (ACS) recommends that men get to decide if they want to be screened, based on a recommendation from their physician and having received information about the risks, benefits and uncertainties surrounding screening. In other words, we don’t even talk about screening anymore; now it’s “Who should have a conversation with their physician about getting screened?”

If you’re age 50 and have an average risk of prostate cancer and are expected to live at least 10 more years. Because prostate cancer grows slowly, if your life expectancy is less than 10 years, you wouldn’t benefit from screening or treatment for prostate cancer.
If you’re age 45 for men and are at high risk of developing prostate cancer. This includes African-Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
If you’re age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Among these groups, when the decision is made to screen, those men will be tested with the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.
Assuming no prostate cancer is found as a result of screening, the need for future screenings depends on the results of the PSA blood test:

Men who choose to be tested who have a PSA of less than 2.5 ng/ml, may only need to be retested every 2 years.
Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher.

Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient’s health, values, and preferences. Please at least have the conversation with your physician.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Prostate Cancer – 2017 Update

September 22, 2017General Health and Wellness844-SMA-TALK, Behind the Curtain, Prostate cancer, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Men (and those who care for men – meaning everyone) should be knowledgeable about prostate cancer. I don’t mean physician-level knowledgeable, but there are just a few facts that you should know that are meaningful. We’ll cover those in this Straight, No Chaser.
Aside from skin cancer, prostate cancer is the most common cancer among men in the U.S. It is also one of the leading causes of cancer death among men of all races. According to the National Cancer Institute, in 2017, there will be over 161,000 new cases and well over 26,000 deaths from prostate cancer. Approximately 11.6% of men will be diagnosed with prostate cancer at some point during their lifetime. Here are some prostate cancer basics.
Prostate NormalCancer
What’s the prostate exactly?
The location and function of the prostate was covered in this previous post.
Who’s at risk for prostate cancer?

Age: This is simple. The older you are, the greater your risk of developing prostate cancer.
Race: Prostate cancer is more common in certain racial and ethnic groups.
Genetics: Your risk is increased, which is not the same as saying you’ll develop it if a family member has. This risk is twice to three times more likely if you have a father, brother or son who has had prostate cancer.

What are the symptoms of prostate cancer?
It is of interest that a wide variety of presentations exists in those later diagnosed with prostate cancer. Some men don’t have symptoms (meaning it’s discovered on screening examinations), and other men present with several symptoms, which may include the following.

Blood in the urine or semen
Difficulty completely emptying the bladder
Difficulty starting urination
Frequent urination (especially at night)
Pain in the back, hips, or pelvis that doesn’t go away
Pain or burning during urination
Painful ejaculation
Weak or interrupted flow of urine

How Is Prostate Cancer Treated?
See the above chart for more detailed information. Optimally, treatment for prostate cancer should take into account

Your age and expected life span with and without treatment
Other health conditions you have
The severity (i.e. stage and grade) of your cancer
Your feelings (and your physician’s medical opinion) about the need to treat the cancer
The likelihood that treatment will cure your cancer or provide some other measure of benefit
Possible side effects from treatment

Different types of established treatments are available for prostate cancer, including the following:

Closely monitoring the prostate cancer by performing prostate specific antigen (PSA) and digital rectal exam (DRE) tests regularly, and treating the cancer only if it grows or causes symptoms. This is known as active surveillance.
Surgery to remove the prostate and or surrounding tissue. This surgery is called a prostatectomy.
Radiation therapy with high-energy rays to kill the cancer..
Hormone therapy perhaps could be named “hormone blocking therapy,” because these medicines blocks cancer cells from getting the hormones they need to grow.

The next Straight, No Chaser will provide an update on prostate cancer screening recommendations.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Prostate Awareness

September 21, 2017Genital/Urinary844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

This is Prostate Cancer Awareness month, and as such, this Straight, No Chaser explores the prostate (no pun intended). Prostate cancer and screening will be addressed in an additional post. There are generally five questions people ask about the prostate, so let’s take the time to address them. These topics are individually discussed in detail at www.sterlingmedicaladvice.com.

1. What is the prostate?

The prostate is a male-only organ located in front of the rectum and under the bladder. It surrounds the urethra, which is the tube through which urine flows on its way out of the penis. Understanding this anatomy helps one understand the nature of problems that arise related to the prostate. Importantly, the prostate is part of the male reproductive system. It’s a gland that contributes to the fluid (seminal fluid) that carries sperm out of the body (i.e., semen).
2. Doesn’t it get infected?

Prostatitis is either inflammation or infection of the prostate gland. It has many different causes. When an infection with bacteria causes prostatitis, it is called bacterial prostatitis. Bacterial prostatitis can be a particularly long-lasting infection, requiring antibiotics to treat.

Acute bacterial prostatitis is an infection that produces signs and symptoms rapidly.
Chronic bacterial prostatitis is an infection that lasts for at least three months.

3. Why does the prostate get large?

A condition known as benign prostatic hypertrophy (BPH) occurs in men as they age. As a general rule, 50% of men have it by age 50, and 80% have it by age 80. The prostate normally is only the size of a walnut. When BPH occurs, the prostate has enlarged to a point where it may press upon the urethra, disrupting the normal flow of urine, preventing normal emptying. It is important to understand that the growth seen in BPH is not cancer.
4. What’s the relationship between the prostate and sex?
When people ask me this question, they have one of two concerns.

Some medical studies have drawn a relationship between a higher frequency of ejaculations and a lower risk of prostate cancer. This trend is not currently considered definitive; to be clear there is no conclusive evidence that the risk of prostate cancer is reduced by frequent ejaculation.
The male equivalent of a “G-spot” is described as being near the prostate.

5. Is prostate cancer deadly?

Prostate cancer is usually slow-growing, but may occasionally be aggressive. Cancerous prostate cells may break off and spread to other parts of the body, particularly the bones and lymph nodes. Prostate cancer usually is seen in men after 50 and even when discovered often doesn’t require especially aggressive management.
Your bottom line? You especially need a prostate exam and other considerations yearly after age 50.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Ovarian Cancer

September 20, 2017General Health and Wellness, Hematology & Oncology/Blood Disorders/Cancer844-SMA-TALK, American Cancer Society, Behind the Curtain, ovarian cancer, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

You are likely aware that the ovaries produce a women’s eggs as well as being the main source of the female’s sex hormones. Ovarian cancer is not the most common gynecological cancer. In fact, it only causes approximately 3% of cancers in women. However, it’s an important one to know because it causes more deaths than any other cancer of the female reproductive system. It is impossible to do justice to ovarian cancer in one blog, so this Straight, No Chaser will feature frequently asked questions on the topic.
How serious is ovarian cancer?

Very. According to the American Cancer Society (ACS), in 2014 the following is expected:

Approximately 21,980 new cases of ovarian cancer
Approximately 14,270 deaths from ovarian cancer

The lifetime risk of dying from invasive ovarian cancer is about 1 in 100.
Who is relatively more likely to obtain ovarian cancer?

Ovarian cancer is more common in whites than African-Americans.
Approximately half of those diagnosed are 63 years or older.

What increases the risk of developing ovarian cancer?

Factors linked to an increase in ovarian cancer risk include the following:

Increasing age, particularly after menopause
Obesity
Breast cancer (those with or have had breast cancer also have a higher risk of ovarian cancer)
Family history of ovarian cancer
Family history of breast or colorectal cancer

Do any actions reduce the risk of developing ovarian cancer?
This needs to be discussed with your physician, as your individual circumstance has a lot to do with actions you can take to lower your risk. That said, general factors linked to a lower risk of ovarian cancer include the following:

Consuming a low-fat diet
Having been pregnant
Having had a hysterectomy (i.e. uterine removal) without removing the ovaries
Having had a tubal ligation (i.e. having had your “tubes tied”)
Having engaged in breastfeeding
Use of birth control pills
Use of the contraceptive injection depot medroxyprogesterone acetate (DMPA or Depo-Provera CI®)

Can ovarian cancer be found early? Are there screening tests?
Only about 1 in 5 ovarian cancers are found at an early stage. Those that do find it early have an improved chance of successful treatment. About 9 out of 10 women treated for early ovarian cancer will live longer than 5 years after the cancer is found. The best way to find ovarian cancer is to have regular women’s health exams and to see the doctor if you have symptoms.
So far, no screening tests have been shown to lower the risk of dying from ovarian cancer, therefore no tests are recommended.
What are the signs and symptoms of ovarian cancer?

Two of the issues in detecting ovarian cancer are symptoms often aren’t present early in the cancer process, and even when symptoms occur, they are easily confused with symptoms more often caused by other things. It’s reasonable to suggest to you that routine evaluation for problems in your gynecological system, particularly those that make you feel different than normal and/or are persistent should prompt an evaluation by a physician.
The most common symptoms are:

Abdominal or pelvic pain
Abdominal swelling or bloating
Difficulty eating and/or a quick sensation of feeling full while eating
Frequent and/or urgent urination

Other symptoms can include:

Abdominal swelling that is accompanied by weight loss
Back pain
Constipation
Fatigue
Menstrual changes
Painful sexual intercourse
Upset stomach

If you have any of these problems, talk to your doctor so that the cause can be found.
Diagnosis, treatment, staging and recovery considerations are discussed at www.sterlingmedicaladvice.com.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Influenza Prevention

September 19, 2017Infectious Disease844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

It’s time to get your flu shots! Of course, many people choose not to get the influenza vaccine (the “flu shot”) for various reasons, some more reasonable than others (including an allergy to eggs). This Straight, No Chaser reviews some of the better options left for you should you choose not to get vaccinated.

The best way to avoid the flu is prevention. Consider adopting these healthy habits before you ever get exposed:

Wash your hands frequently with warm soapy water. You know when they’re dirty. Most certainly wash your hands before you use them to eat or put anything else in your mouth.
If you can’t wash your hands, use an alcohol-based hand sanitizer.
If your hands are dirty and neither soap nor sanitizer is available, still rinse and dry your hands with warm water if you can.
Use disinfectant to clean surfaces.
Avoid unnecessarily touching your eyes, nose, or mouth.
Politely limit close contact with people who are ill, coughing and sneezing.
When coughing or sneezing use the bend of your elbow or a facial tissue to help cover your nose and mouth. Learn to avoid coughing or sneezing into your hands.
When you become sick, stay home. It’s the proper thing to do to avoid spreading your infection to others.

Vitamin C, echinacea and zinc have long been touted to prevent colds and influenza. There are no studies confirming or refuting this claim. Despite assurances that these and other herbal medicines are safe alternatives because they’re “natural”, the active ingredients in them are the same as found in certain prescription medicines. Thus they too may interact with other medications and worsen certain medical conditions. Given this, you should discuss your use of supplements with your physician or pharmacist prior to use.

Another level of defense for you involves use of certain antiviral prescription medications. If you are exposed to someone (e.g. a family member) with influenza, and especially if you begin having flu-like symptoms, immediately contact your physician to discuss taking medicines to prevent catching the flu. Such medications include Tamiflu® (generic name: oseltamivir), Relenza® (generic name: zanamivir), Flumadine® (generic name: rimantadine) and Symmetrel® (generic name: amantadine). If you make the request more than 24-48 hours after the onset of symptoms, you likely won’t be given the medication, since it isn’t likely to be effective outside of this timeframe.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Malnutrition

September 18, 2017Diet and Nutrition, General Health and Wellness, Health Prevention844-SMA-TALK, Behind the Curtain, dehydration, Diarrhea, malnutrition, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Do you know someone so poor that eating is a constant concern? Do you have a child who is a finicky eater? Have you ever been concerned that your child might become malnourished? Whether or not your thoughts have reached the level of concern, you should be aware of the notion. After all, malnutrition is directly responsible for 300,000 deaths per year in children younger than 5 years old, especially in developing countries. It is the number one cause of child deaths across the world, contributing directly or indirectly to over half of all deaths in children. According to the UN World Food Programme, 925 million people in the world do not have enough to eat.
What is malnutrition?

Malnutrition is a state of being in which the body fails to receive adequate nutrition, and this state prevents proper health and development.
Causes of Malnutrition
All over the world, the poor are at the greatest risk malnutrition. Wars and natural disasters such as droughts, tsunamis, hurricanes and earthquakes can have disruptive effects on food production and distribution, contributing to hunger and subsequent malnutrition.
Also those who can’t respond to the body’s hunger signals (e.g. due to injury or loss of extremity use while living without adequate support; aging or other illness may reduce appetite) are at risk for malnutrition. However, someone can become malnourished for reasons that have nothing to do with hunger. You can still be malnourished even relatively having plenty to eat if the foods consumed don’t provide the right nutrients, vitamins, and minerals.

Another consideration in malnutrition is the presence of a disease or conditions that prevents you from digesting or absorbing your food properly. For example:

Someone with celiac disease has intestinal problems that are triggered by a gluten, which is a protein found in wheat, rye, and barley.
Those with cystic fibrosis have trouble absorbing nutrients because the disease affects the pancreas and its ability to produce enzymes necessary for digestion.

Malnutrition can be limited to a specific nutritional deficiency. The World Health Organization (WHO) estimates that as many 2 billion people worldwide have insufficient dietary intake of nutrients like iron, vitamin A, and zinc.

Iron deficiency is the most common nutritional deficiency in the world. You may be aware that this deficiency causes anemia and can retard development in kids.
Vitamin A deficiency from malnutrition is the chief cause of preventable blindness in the developing world; it also increases the risk of dying from infections, from measles, or diarrhea.

What are the symptoms of malnutrition?

Malnutrition negatively impacts both the body and the mind; as such, a variety of symptoms are produced.

Hunger is a sign that your body needs food. You need food to assist your various organs in performing adequately.
If you’re malnourished, your immunity is reduced. This means you more likely to become sick from a variety of causes.
Malnourished individuals are likely to be significantly underweight.
Malnourished children’s growth may be stunted, making them much shorter than average.

Other symptoms include the following:

Abnormal bodily organ function
Decaying teeth
Dizziness
Dry, scaly skin
Fatigue and low energy
Learning difficulty
Muscle weakness
Osteoporosis (fragile bones that break easily)
Poor attention span
Stomach bloating
Swollen and bleeding gums
Slowed reaction times

Those pregnant and malnourished, may have offspring that weigh less at birth and have a lower chance of survival.
Addressing hunger and malnutrition

There are two considerations here: limiting your risk and treating hunger and malnutrition.

In the U.S., foods are typically fortified with vitamins and minerals to prevent certain nutritional deficiencies. For example, adding iodine to salt helps prevent some thyroid gland problems (such as goiter), folic acid added to foods helps prevent certain birth defects, and supplemental iron can help prevent iron-deficiency anemia.
Alcohol can interfere with nutrient absorption such that even if vitamins and minerals are consumed, alcoholics can still develop deficiencies. It’s more likely that alcoholics aren’t engaging in healthy eating habits.
Vegetarians, vegans and others on special diets should be mindful to eat balanced meals and a variety of foods to get the right nutrients.

Treating Malnourished Children

Fortunately, many of the harmful effects of malnutrition can be reversed, especially if a child is only mildly or briefly malnourished. You don’t need a pill. Learn to engage in healthy eating habits, which can be done at any budget. The best way to ensure that kids are properly nourished is to serve a variety of healthy foods. Try to limit unhealthy snacks and those empty calories that make them feel full prior to getting adequate nutrition with their meal. If you’re concerned that your child’s energy level is lagging or that he or she isn’t growing normally, ask your physician for an evaluation.
If you think your child isn’t getting enough of the right nutrients, talk to your doctor. Fortunately, many effects of malnutrition can be reversed if it’s early in the process. Unfortunately, too often malnourished children aren’t discovered until the effects of malnutrition have permitted other illnesses to take hold.

As a final thought, please consider supporting one of the entities dedicated to combating hunger. To support Feeding America, visit their site at http://feedingamerica.org. Around the world, you can support organizations such as Hunger Relief International; visit their site at www.hungerreliefinternational.org.

Straight, No Chaser: When Your Headache is Life-Threatening

September 17, 2017Neurology844-SMA-TALK, arteriovenous malformation, AV malformation, Behind the Curtain, Carbon monoxide poisoning, Conditions and Diseases, encephalitis, meningitis, Migraine, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, Subarachnoid bleed, temporal arteritis, There are 72 Hours in a DayJeffrey Sterling, MD

All headaches are not created equal. Earlier we discussed migraines, but there’s a lot more to headaches than those. In fact, when you come to an emergency room with a history of migraines and tell us you’re having a migraine, we aren’t thinking about migraines first. The ER is all about the life-threats.

The lead picture suggests items to avoid if you’d like to improve your prognosis for headaches in general and especially certain ones like brain aneurysms. In other words, alcohol, cocaine and cigarettes increase your risk for life-threatening causes of headaches.

Secondary headaches are those related to some other illness or condition that produces headaches as a symptom. These are much more common causes of headaches than migraines. They’re even more important because they could represent life-threatening conditions. So we’ll put aside the headaches caused by things like panic attacks and hyperventilation, influenza, dental pain, sinusitis, ear infections, eye strain, dehydration, hangovers, hunger and “brain-freeze.” (Yes, “ice-cream headaches” are a real thing!) Today we’ll point you to some conditions about which you should be concerned. (I’m intentionally leaving out especially uncommon ones and otherwise esoteric conditions. I wouldn’t want to encourage any hypochondriacs out there.)

AVM (arteriovenous malformation): an abnormal formation of blood vessels inside your brain
Concussions and post-concussive syndrome
Brain aneurysm: a ballooning of one of your brain’s arteries that can steal blood away from needed areas

Brain tumor
Carbon monoxide poisoning: from breathing exhaust fumes
Encephalitis/Meningitis: inflammation and/or infection of different components of your brain
Subarachnoid and other intracranial hemorrhage: bleeding inside various parts of the brain

Stroke
Temporal arteritis: inflammation of an important forehead artery with potentially devastating consequences to your sight

Given that I’ve blogged on several of these already (you can always enter the term in the search box on the right for more details), I’m going to focus on the symptoms that may suggest your headache is different enough to get evaluated for a possible life-threat.
Consider this a “headache plus this symptom = go to the emergency room” list.

Altered mental status
Confusion
Difficulty standing or walking (different from baseline)
Fainting after a headache
High fever, greater than 102 F to 104 F (39 C to 40 C)
Nausea or vomiting that’s not hangover related
Numbness, weakness or paralysis on one side of your body
Slurred speech
Stiff neck
Vision disturbances (blurred or inability to see)
Worse headache of your life

Unfortunately, defenses go down in (and when evaluating) those with a history of headaches. This places you at additional risk. Even if you have had headaches before, if you have new symptoms or something seems different about a new episode, the decision to get evaluated could save your life.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
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Straight, No Chaser: Getting Your Pain Treated at the Emergency Room

September 16, 2017General Health and Wellness844-SMA-TALK, American Chronic Pain Association, American College of Emergency Physicians, Behind the Curtain, chronic pain, narcotics, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Both the American College of Emergency Physicians and the American Chronic Pain Association have worked diligently to offer information and recommendations to protect patient interests and prevent inappropriate emergency room utilization while respecting the needs of chronic pain patients experiencing acute exacerbations.
In a word, it’s about expectations. Learning to understand what’s reasonable and not so much in an emergency room setting is important in helping patients to avoid disappointment.
Here are some tips to help your emergency room team help you.
If you don’t prepare for an emergency room visit, you’re the one who’s going to end up disappointed.

You should be able to tell the staff the name of the condition from which you suffer.
You should know the name and the contact information of your primary physician and any pain management specialist you see.
You should know the names of your medications, including over the counter and herbal preparations.
You should know any medical allergies you have. (A word about this. There is a difference between a medical allergy and an adverse reaction to a medication. Just because a medicine upsets you stomach or isn’t as effective as another doesn’t mean you’re allergic to it. It’s insulting to your physician to insist that you have an allergy when you don’t. You can assume that taking this posture starts the relationship off poorly because the physician will often know better and in many cases can check or test you for true allergies. It’s ok to be honest about your concerns, including medications that seem to work better than others. Your physicians will work with you and will do so more willingly when you are completely honest.)

At the ER
If you’re dealing with chronic pain, you’re going to end up in an emergency room at some point. The experience doesn’t have to be unpleasant. Emergency physicians are quite aware that pain is woefully under-treated and really do want to address it when it exists. That said, it’s important to be aware that physicians’ first charge is to “Do No Harm,” and if the situation is such that it could lead to inappropriate treatment, other and possible greater concerns than your immediate pain may take priority in the mind of the physician. It’s not that this applies to you, but this is what we have to protect against:

Here are other things to appreciate when you come to visit:

Your presence doesn’t change the reality that life-threatening conditions may be present at the same time in the emergency room. Be patient. You’re not being ignored.
Your physicians are going to treat your pain, but they’re even more interested in finding and treating any disease that exists. Be patient.
Your physicians are going to attempt to coordinate your care with your primary physicians and/or your pain management physicians.
You can’t just come to the emergency room and start demanding narcotics, even if it’s what is eventually going to happen. I shouldn’t have to explain that.

You can’t come to the emergency room and claim medical allergies to every medication except for a specific pain cocktail. Your physician understands that your body doesn’t work that way.
You shouldn’t expect an emergency physician to immediately be able to make a diagnosis of your condition that has eluded other physicians who have been evaluating you for months or years.
You shouldn’t expect an emergency physician to provide you with more than a few days of pain medication (or any without a discussion with one of your physicians).
You should expect to receive a thorough evaluation of your condition and to be treated with respect.
You should expect to receive treatment based on the evaluation performed in the emergency room.

You have a role to play in the treatment of your pain in an emergency room. The more prepared you are and better able you are to discuss your current situation in the context of your long-term care, the more likely you are to have a successful interaction and treatment experience. Although you never know when pain will strike, taking the time to organize the information described above will work to your advantage.

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